A standard deduction of $150 will be reflected in your November 2022 Statement of Accounts. Please only submit this form if you wish to contribute more than the standard amount or opt out of this program. 

Thank you for your generosity in showing appreciation to our Team Members.

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* 1. Membership Number (e.g. A123400)

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* 2. Name

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* 3. I'd like to make a gift of:

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* 4. I would like to opt out of this program and do not want to contribute to the Annual Staff Holiday Fund FY2023.

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